What’s the minimum group size required for a quote?

The minimum group size for our plans is 10 employees. However, we also offer standardized plan options for small businesses with 2–9 eligible/enrolled employees. Rates for these group segments are pooled for best overall savings.Return to top

What’s the minimum contribution level from the employer?

The minimum contribution level from the employer is 50 percent of the employee rate, unless you are selling a voluntary program.Return to top

What’s the minimum participation requirement?

Delta Dental requires a minimum participation of 75 percent of the eligible employees (35 percent with voluntary plans) with a minimum of 10 employees.Return to top

How many employees are required to quote orthodontics?

We require a minimum of 25 employees before we will quote orthodontics, unless the group had orthodontic coverage through their previous carrier.Return to top

Are there any waiting periods for services?

No. Delta Dental does not have waiting periods for services, except for our voluntary plans.Return to top

What’s the waiting period for new hires?

The waiting period for new hires is usually a minimum of 30 days after the date of hire. A few industries require a mandatory 90-day new hire waiting period, such as doctors, lawyers, architects, auto dealerships, and country clubs. Our voluntary plans also include waiting periods.Return to top

Does Delta Dental have a pre-existing condition clause?

No. Delta Dental’s programs have no exclusions or limitations for pre-existing conditions.Return to top

Explain Delta Dental’s position on Certificates of Portability.

Dental is excluded unless the medical and dental are tied together. Since Delta Dental underwrites plans on a stand-alone basis, the aspects of HIPAA concerning certifications of creditable coverage do not apply. (Also, Certificates of Portability were created to address pre-existing condition clauses. Delta Dental does not underwrite plans with pre-existing condition clauses.)Return to top

Do enrollees experience balance billing with Delta Dental?

No. Delta Dental enrollees are responsible only for their copayments, deductibles, and charges for noncovered services, if any, when they visit a participating Delta Dental dentist. Our participating dentists agree to accept our fee determination as full payment for covered services.Return to top

What materials will the enrollees receive after the program is implemented?

Our standard materials include a program certificate booklet along with a summary of dental plan benefits describing the coverage levels. Additionally, the group will receive an administrative manual, eligibility enrollment forms, a dentist directory (if applicable), and a re-order form for materials.Return to top

What are the commissions paid by Delta Dental?

Delta Dental offers a flat percentage based on group size. Please see our contract or Agent Commission Schedule. Outside of this schedule, commissions can be determined on a group-specific basis, subject to rating adjustment.Return to top

Explain the methods of reporting eligibility.

Methods of reporting eligibility include online, tape, enrollment forms, diskettes, and forms used by some other carriers.Return to top